• Elisa Cortijo, Ángel L Guerrero-Peral, Sonia Herrero-Velázquez, Patricia Mulero, María Pedraza, Johanna Barón, Carolina de la Cruz, Marina Ruiz, Dulce M Campos-Blanco, Javier Marco-Llorente, Esther Rojo-Martínez, and Rosa Fernández.
• Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España.
• Rev Neurol. 2012 Sep 1; 55 (5): 270-8.

IntroductionHemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a response to indomethacin, which is not always well tolerated.AimsWe report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin.Patients And MethodsBetween January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service.ResultsThe age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted over three months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a full response in 53.8% and a partial response in 38.5%.ConclusionsHemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatable condition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration when indomethacin is not well tolerated.

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